Embolization of Posterior Epistaxis

Abstract

Few reports address using selective arterial embolization for controlling posterior epistaxis. Internal maxillary artery ligation is an effective method of control but suffers from requiring an operation in an already traumatized field and may fail due to variations in arterial arborization and collateral circulation. Selective angiographic embolization can determine the site of bleeding and control it, obviating the need for surgery, continued packing, and its sequellae. Sixteen patients underwent embolization for uncontrollable epistaxis. One patient had transient diplopia during the angiogram. There were no permanent complications. Within hours of the procedure, 12.5% experienced transient neurologic symptoms that resolved. All patients were controlled. Within 24 hours of the embolization, 87.5% were unpacked. The average length of stay was 5 days. When corrected for days admitted because of posterior packing, the length of stay decreased to 3.9 days. It is concluded that embolization is a safe, efficacious, cost efficient method of controlling posterior epistaxis.